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Continuity of Care (Article 7)
Consult Reports Can Make the Difference
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As you know, TRICARE Prime beneficiaries’ care is coordinated by a primary care manager (PCM). Whether the PCM is military or civilian, the quality of care patients receive depends in part on the level of communication that exists between the PCM, the beneficiary and the specialists the beneficiary has been referred to.

One communication vehicle that PCMs rely on is the consult report. Returning consult reports, operative reports and discharge summaries to the initiating provider is important for timely follow-up and continuity of care.

Existing TRICARE operating procedures require consult reports be returned to the PCM or initiating provider within 10 working days of the patient encounter.

Delaying those reports beyond the 10-day time period could slow down a patient’s treatment program.

In addition to doing all you can to meet the 10 working days deadline, it’s important that reports documenting routine specialty referrals for office visits,  outpatient services and inpatient services be complete and legible. Otherwise they may not fulfill their objective: providing PCMs with the information they need to effectively meet patients’ needs.

Providers who treat TRICARE beneficiaries coming from the local military treatment facility may receive a faxed reminder to return a consult report for a recent visit/service. Your office should return the consult report, operative report or discharge summary requested using the faxed consult report reminder as the cover sheet on your return transmission.

Please use the fax number listed in the center of the reminder page. This fax number is shown only on the reminder fax to providers for each beneficiary consult return request. This is to avoid having providers send documentation on all other TRICARE beneficiaries.


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Electronic Claims Filing Assistance (Article 8)

TRICARE requires all network providers to file claims electronically.

For assistance with any issues related to electronic media claims (EMC) submission for the TRICARE South Region, you can contact the PGBA EMC Help Desk at 1-800-325-5920, option 2.

You can also visit the Provider Handbook or PGBA Web site  for more information regarding electronic claims submission.


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Keep Your Information Up to Date (Article 9)

The next time you log on to the Humana Military Web site as a registered member with your ID and password, a separate screen will pop up that reads “Review Your Provider Locator Information.”.

Please take a minute to update your information—especially regarding whether or not you’re accepting new patients.

Keeping your data current ensures that you receive information from Humana Military, that you receive your claims payments, and that new patients can find you when they go to the Provider Directory.
Download TRICARE-related fee schedules into your office’s accounting system.


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Last Reviewed:  February 2, 2007